Cardiovascular disease is the major cause of morbidity and mortality in the United States. In fact, 1 in 3 deaths in 2005 was due to cardiovascular disease (CVD), most of those due to coronary heart disease, and one in 3 Americans carry a diagnosis of CVD. The need for improved noninvasive methods to detect early cardiovascular disease and to help manage patients with chronic disease has therefore never been as critical. In addition, the development of molecular cardiovascular imaging is a recent advance that makes noninvasive imaging even more promising. The number of physicians who have in-depth training and expertise in the physics, engineering, molecular, and translational applications in cardiovascular imaging remains limited. The University of Virginia is one of a handful of centers in the U.S. that have high-level clinical, physics, engineering, and molecular expertise in all 4 cardiovascular imaging modalities as well as a track record of training physicians in all. The purpose of this grant renewal proposal is to continue the research training program that provides comprehensive training in all four cardiovascular imaging modalities, including molecular imaging. This program provides trainees with outstanding opportunities to interact with imaging physicists and engineers who together offer the promise of improvements in the clinical applications of newer technologies. Each trainee is mentored by both a PhD scientist and a MD clinician scientist to ensure an integrated training experience. The goal of the training is to develop the next generation of academic clinician investigators in cardiovascular imaging who can interact across basic and clinical imaging science. Trainees undergo a rigorous 2-year research training program following a 2 -year clinical cardiovascular training program completed at the University of Virginia or a 3-year program completed at another institution. Two fellows per year enter the program such that there are 4 fellows enrolled at any one time. A complete didactic program is offered including instruction in imaging physics and engineering, molecular imaging, statistics, epidemiology, clinical research methodology, and medical ethics. Research training is comprehensive and combines clinical and basic cardiovascular imaging research for each trainee.